ABSTRACT
Introduction:
A challenging situation in proximal hypospadias is the presentation of patients with successful urethroplasty but with persistent or recurrent ventral curvature (VC) after multiple hypospadias repair.
Materials and Methods:
We present a 13 year-old boy with 7 previous surgeries (long TIP, Duplay, meatoplasty) to treat hypospadias presenting with 60 degrees of VC, in spite of a well-accepted coronally neomeatus. We degloved the penis and artificial erection clearly appointed corporal disproportion causing curvature. We disconnected urethra from corpora. After excision of remnant fibrotic tissue, there was a residual curvature so a lenghtening corporoplasty with dermal graft from groin was performed. We have adjusted the urethral meatus position into a proximal penile shaft. We used a buccal mucosa graft placed in an inverted U-shape position planning a second stage urethroplasty (11 Barroso U Jr, Macedo A Jr. Initial experience with ‘inverted U’ staged buccal mucosa graft (bracka) for hypospadias repair. J Pediatr Urol. 2009; 5:90-2.). An indwelling silicone Foley tube was left for one week. The patient was discharged the day after surgery.
Results:
The aspect after corporoplasty proved satisfactory curvature correction. Patient had an excellent outcome and is scheduled for a second-stage after 6 months.
Discussion:
Snodgrass and Bush (22 Snodgrass W, Bush NC. Persistent or recurrent ventral curvature after failed proximal hypospadias repair. J Pediatr Urol. 2019; 15:344.e1-344.e6.) reported that on 73 patients with an average of 2.7 operations for proximal shaft to perineal hypospadias; of which, 83% had VC at re-operation averaging 50°. We do believe that some good results with minimal dorsal plicature may recur in adolescence and therefore when these procedures may be considered, they should be performed by classic Nesbit technique (33 Nesbit RM. Operation for correction of distal penile ventral curvature with or without hypospadias. J Urol. 1967; 97:720-2.). Otherwise, the choice for primary ventral lengthening should be taken.
Conclusion:
Severe curvature associated with hypospadias should undergo a major procedure at early stage to avoid decompensation after dorsal plicature in adolescence. We had a very satisfactory result, the patient awaits the second stage procedure (Figure-1).
REFERENCES
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1Barroso U Jr, Macedo A Jr. Initial experience with ‘inverted U’ staged buccal mucosa graft (bracka) for hypospadias repair. J Pediatr Urol. 2009; 5:90-2.
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2Snodgrass W, Bush NC. Persistent or recurrent ventral curvature after failed proximal hypospadias repair. J Pediatr Urol. 2019; 15:344.e1-344.e6.
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3Nesbit RM. Operation for correction of distal penile ventral curvature with or without hypospadias. J Urol. 1967; 97:720-2.
Publication Dates
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Publication in this collection
11 Mar 2022 -
Date of issue
Mar-Apr 2022
History
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Received
27 Apr 2021 -
Accepted
12 May 2021 -
Published
20 June 2021